Student athletes at risk: Concussion essentials

Drs. Bass and Valasek’s article in the August 2018 issue of Contemporary Pediatrics titled “Sports-related concussion: When it’s OK to return to play” provides a comprehensive review of sports-related concussions (SRC) including the pathophysiology, symptoms, diagnosis, and cognitive assessment using the rigorously tested sideline Sports Concussion Assessment Tool-5th Edition (SCAT5).¹ Exemplar cases are provided by authors Echemendia and colleagues that can be used to assess the readers’ personal knowledge on sideline and follow-up assessments for SRCs.

How you, the reader, answer these questions should direct your interest in reading their article:

1. Are you confident in your skills to administer the SCAT5?

2. Should you administer the SCAT5 in your office on day 7 after an athlete has sustained an SRC?

3. What are the differences between the recommendations for administering the SCAT5 and the office/off-field assessment for SRC?

4. What are the specific recommendations for duration of time between the SRC and return-to-play (RTP)?

5. How does second-impact syndrome impact RTP?

The answers to each of these questions and more are answered by Drs. Bass and Valasek’s article, which is especially timely given the seasonal ramp-up of back-to-school sports.

Spotting SRC-advances and insights

New insights for assessments and treatment planning-as well as medical research on SRC-have emerged after numerous professional football players, who sustained one or more concussions during play without scientifically based care, suffered long-term adverse cognitive outcomes. These insights have positively impacted the science of assessment, immediate diagnosis, and treatment planning for all athletes, including high school and college players. Emphasis of care now focuses on prevention, early recognition, and conservative treatment for athletes with SRC.

The NP’s role

The initial role for nurse practitioners (NPs) [including pediatric (PNPs), family (FNPs), and adult geriatric (AGNPs)], who care for high school and college athletes in school-based health centers (SBHCs), on college campuses, and in ambulatory and hospital settings, often involves obtaining the detailed sports history, performing the physical examination, and evaluating the findings to determine if the athlete is safe to participate in the sport of his/her choice, as well as determining ways to correct problems identified prior to participation. It is critical for NPs to query adolescents and young adults about prior sports participation, injuries, and treatments. Safety cannot be overemphasized. We NPs must consider the sport and all the ramifications related to potential for sustaining an SRC and emphasize wearing of properly fitted protective equipment as a primary prevention strategy.

Football and soccer are on the top of the list for SRC, but consider all the sports that have the potential for SRC, including but not limited to: boxing, bike riding, skateboarding, baseball, lacrosse, diving, and off-roading with all-terrain vehicles. Additionally, NPs must consider that adolescents and young adults are also ‘risk-takers’ and may not recognize safety as a priority.

Ask-and consider SRC!

Have you heard one or more of these statements from an adolescent or young adult athlete? “I can’t think straight.” “I can’t concentrate on my school work.” “I am usually a good student-I just don’t understand what’s happening, my grades are falling.” Although the diagnosis of an SRC is more likely to be made when there is a known event of a head trauma, should a differential diagnosis of an SRC be considered when an adolescent or young adult presents with any of these statements?

When a parent is questioned about the adolescent’s statements, the parent may blame the change on “typical adolescent behaviors.” Don’t be fooled. Consider a possible SRC and ask appropriate history questions. Consider this: How many children, adolescents, and adults in your neighborhood are riding a bike or skateboard and wearing a helmet and protective gear? My guess is the number is very few, despite state laws that mandate bike helmets for children and young adolescents. How many adolescents and young players always wear their protective gear during sports?

To avoid making a medical error by missing the diagnosis of an SRC, NPs need to ask the questions others may not.

References:

1. Echemendia RJ, Meeuwisse W, McCrory P, et al. The Sport Concussion Assessment Tool 5th Edition (SCAT5): background and rationale. Br J Sports Med. 2017;51(11):848-850.